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General NPI Number Information
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NPI Number | 1336887876
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Entity Type | Organization
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Legal Business Name | CROSS WELLNESS CENTER
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 701 E 28TH ST STE 301
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City | LONG BEACH
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State | CA
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Zip | 90806-2777
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Country | US
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Telephone | 213-598-4979
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Fax | 562-490-9841
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Provider Business Mailing Address
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Address Line | 620 S GRAMERCY PL APT 404
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City | LOS ANGELES
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State | CA
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Zip | 90005-3272
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Country | US
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Telephone | 213-598-4979
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Fax | 562-490-9841
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Authorized Official
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Title or Position | MD
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Name | KIM PHILLIP
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Credential |
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Telephone | 213-598-4979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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